Concerted effort from leading health experts offers global prescription to tackle the most fatal diseases
22 November 2007
The major research and policy objectives needed to reduce the rising toll of slow killer illnesses have been agreed for the first time by the world’s leading health experts. They have identified 20 ‘Grand Challenges’ in chronic non-contagious diseases and reached a global consensus on the 20 foremost measures needed to curb the rise in preventable deaths. This research and the resulting programme are set out in Nature.
These illnesses are reaching world epidemic proportions and include cardiovascular diseases (mainly heart disease and stroke), several cancers, chronic respiratory conditions, and type 2 diabetes.
In their paper for Nature, the 19 authors including MRC Chief Executive Sir Leszek Borysiewicz say chronic non-communicable diseases:
- Cause the greatest share of death and disability worldwide;
- Account for over 60% of deaths worldwide, four-fifths of those fatalities being citizens of low and middle income countries;
- Cause twice as many deaths as the combined total of HIV/AIDS, tuberculosis, malaria, conditions surrounding pregnancy and childbirth, and nutritional deficiencies.
Researchers used the consensus-building “Delphi” technique to create the “Grand Challenges in Chronic Non-Communicable Diseases (CNCDs)” – a distillation of informed opinions drawn from 155 panel members across 50 nations. The result is an authoritative list of the 20 most important challenges and actions to restrain and reverse the toll of these slow killer illnesses. The list of Grand Challenges is accompanied by research priorities for meeting them, drawn from the study data and finalised by 27 leading world health figures guiding the project.
CNCDs, defined by the WHO as cardio-vascular disease, type 2 diabetes, chronic respiratory diseases and certain cancers, are largely preventable. It’s estimated that eliminating key risk factors (poor diet, physical inactivity, smoking) would prevent 80% of heart disease, strokes and type 2 diabetes, and over 40% of cancer cases.
Sir Leszek Borysiewicz said “Our aim was to galvanize the health, science and public policy communities across boundaries into action on this epidemic and to foster global debate, support and funding. It is not enough for each country to tackle these major killers in isolation. We must co-ordinate our efforts to get results as quickly as possible.”
Leading partners behind the project are the McLaughlin-Rotman Center for Global Health (University Health Network and University of Toronto), Toronto; the Oxford Health Alliance, London; the Medical Research Council, London; the Canadian Institutes of Health Research, Ottawa; and the US National Institutes of Health, Bethesda.
“The 20 Grand Challenges are equally pressing – there is no priority assigned within the list,” says lead author Dr. Abdallah S. Daar of the McLaughlin- Rotman Center.
The Grand Challenges are grouped under six broad goals:
- Reorient health systems (e.g. “Allocate resources within health systems based on burden of disease”);
- Mitigate health impacts of poverty and urbanization (e.g. “Study and assess how poverty increases risk factors”);
- Engage businesses and community (e.g.: “Make business a key partner in promoting health and preventing disease; Develop and monitor codes of responsible conduct with the food, beverage and restaurant industries”);
- Modify risk factors (e.g.: “Deploy universally measures proven to reduce tobacco use and boost resources to implement the WHO framework Convention on Tobacco Control”);
- Enhance economic, legal and environmental policies (e.g. “Study and address the impacts of poor health on economic output and productivity”); and
- Raise public and political awareness (e.g.: “Promote healthy lifestyle and consumption choices through effective education and public engagement”).
The Grand Challenges in CNCDs complement the “Grand Challenges in Human Health,” published in 2003 by the Bill and Melinda Gates Foundation and partners, an initiative focused mainly on infectious disease, especially in developing countries.
“Without concerted action, some 388 million people will die of one or more CNCDs in the next 10 years,” according to co-author Nizal Sarrafzadegan, Professor, Isfahan University of Medical Sciences, Iran. “With concerted action, the number of premature deaths prevented by 2015 would total at least 36 million – a number of people roughly equal to the population of Canada, Algeria or Kenya.”
Noting the economic impact of CNCDs, co-author Robert Beaglehole, former WHO Director (Department of Chronic Diseases and Health Promotion), says that unless serious action is taken now, over the next decade China, India and the U.K. will lose an estimated £229 billion, £116 billion and £17 billion respectively in national income due to heart disease, stroke and diabetes.
The Grand Challenges Global Partnership is being established with a secretariat at the Oxford Health Alliance (www.oxha.org), funded for the first five years by OxHA members. The Partnership is intended as a platform for collaboration of global research funding organisations. An advocacy program to be developed will encourage adoption of the Challenges and Goals.
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